pleural effusion vs pulmonary edema

Just this evening we had class discussion on pleural effusion.

The scenario was of a 70 year old men underlying pleural tapping the past six months and 7pack years of smoking now presented to Hospital Teluk Intan complaining of progressive shortness of breath with cough.

at first most of us just want to diagnose as chronic pulmonary obstructive disease (COPD) due to productive cough and smoking history, but then with past history of pleural effusion and not more than 10 packed years of smoking we decide to discuss the case as pleural effusion.

the examination wise shows stony dullness, reduced chest movement, trachea towards opposite side.
chest x ray shows heterogenous opacity on apex and lower zone.

on discussion we must know the definition of pleural effusion. some mistaken it for pulmonary edema.
ok. in a simple words pleural effusion is excess fluid that accumulate in the pleural cavity, which is the fluid filled space that surrounds our lungs.

Normally, only teaspoons of watery fluid are present in the pleural space, allowing the lungs to move smoothly within the chest cavity during breathing. if in excess these fluid can impair breathing by mass effect, also it can limit the expansion of lung during the ventilation. Also in a pleural effusion its important to know the difference between exudate and transudate. exudate are simply inflammatory fluid leaking between cells, transudate are produced through tissue filtration without causing any capillary injury.

Meanwhile pulmonary edema is the accumulation of fluid in the air spaces and parenchyma of the lung. it leads to impaired gas exchange. it can either be due to failure of the left ventricle, injury to the lung parenchyma or vasculature of the lung.



So let us not mistaken these two. the management also differs. In pleural effusion, it depends also on the cause of effusion. if heart failure then gives furosemide. Also can remove the fluid by thoracentesis which is removing of fluid out of pleural space.

As for pulmonary edema, the initial management is supporting vital function.supply oxygen in hypoxic patient, tracheal intubation and mechanical support in preventing airway compromise. next priority is treating the underlying cause. for example pulmonary edema due to infection should require antibiotics.

I hope thats all to explain regarding these 2 important disease. May Allah grant us all istiqomaah in doing good things.